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Meta-Analysis
. 2018 Jun;55(6):613-625.
doi: 10.1007/s00592-018-1131-1. Epub 2018 Mar 26.

Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis

Katherine T Li  1 , Shilpa Naik  2 , Mallika Alexander  3 , Jyoti S Mathad  4
Affiliations
Meta-Analysis

Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis

Katherine T Li et al. Acta Diabetol. 2018 Jun.

Abstract

Aims: Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India.

Methods: We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias.

Results: We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit.

Conclusions: In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.

Keywords: Gestational diabetes; India; Pregnancy; Screening.

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Conflict of interest statement

Compliance with ethical standards: Conflict of interest: All the author declares that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of study selection
Fig. 2
Fig. 2
Median prevalence estimates by state/territory. Number of studies for each state/territory shown in bold. Figure made using mapchart.net
Fig. 3
Fig. 3
Distribution of prevalence estimates by screening criteria used. *Other: One study used the WHO99 criteria for type 2 diabetes (fasting > 140 mg/dL or 75 g OGTT 2 h value > 200 mg/dL). One study used 75 g 2 h value > 144 mg/dL. One study used a combination of C&C and IADPSG criteria
Fig. 4
Fig. 4
Results from meta-regression and subset meta-analyses
See this image and copyright information in PMC

References

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    1. Veerasamy S, Kapur A, Balaji V, Divakar H. A perspective on testing for gestational diabetes mellitus. Indian J Endocrinol Metab. 2015;19(4):529–532. - PMC - PubMed
    1. Gupta Y, Kalra B. Screening and diagnosis of gestational diabetes mellitus. JPMA. 2016;66(9 Suppl 1):S19–S21. - PubMed

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